摘要
目的总结老老年重症心力衰竭患者死亡情况并对其影响因素进行分析。方法连续入选2011~2016年在北京市朝阳医院心脏内科住院的年龄≥75岁,纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级的重症心力衰竭患者233例,进行电话或者门诊随访,并记录发生全因死亡的原因及时间,根据受试者是否生存生分为死亡组(146例)和生存组(87例),采用Cox回归分析对影响患者全因死亡的因素进行分析。结果中位随访26个月,入组患者全因死亡率为62.7%(146/233)。Cox多因素回归分析显示,年龄≥81岁(HR=1.733,P=0.007)、舒张压≤60 mmHg(HR=0.612,P=0.028)、血肌酐≥120μmol/L(HR=2.086,P<0.001)、N末端B型利钠肽原(NT-proBNP)≥2680 ng/L(HR=1.533,P=0.001)、左心室射血分数(LVEF)≤35%(HR=0.622,P=0.022)是患者全因死亡的独立预测因素;以上预测因子的ROC曲线下面积(AUC)为0.729(95%CI 0.663~0.795,P<0.001),提示这些因素可以较好地预测患者全因死亡发生情况。结论老老年重症心力衰竭患者预后差,病死率高,年龄、舒张压、血肌酐、NT-proBNP以及LVEF是影响患者全因死亡的独立预测因子。
Objective To summarize the mortality of very elderly patients with severe heart failure and analyze its influencing factors.Methods 233 patients with severe heart failure who were hospitalized in the Department of Cardiology of Beijing Chaoyang Hospital from 2011 to 2016,aged≥75,and whose cardiac function was classified asⅢ~Ⅳby the New York Heart Association(NYHA),were selected for telephone or outpatient follow-up;and the causes of all-cause death were recorded.According to whether the subjects survived or not,they were divided into the death group(n=146)and survival group(n=87);Cox regression analysis was used to analyze the factors affecting all-cause death.Results After a median follow-up of 26 months,the mortality was 62.7%(146/233).Cox multivariate analysis showed that age≥81(HR=1.733,P=0.007),diastolic blood pressure≤60 mmHg(HR=0.612,P=0.028),serum creatinine level≥120μmol/L(HR=2.086,P<0.001),NT-proBNP level≥2680 ng/L(HR=1.533,P=0.001)and LVEF≤35%(HR=0.622,P=0.022)were the factors affecting all-cause death.The area under curve(AUC)of prognostic factors was 0.729(95%CI 0.663-0.795,P<0.001).Conclusion The prognosis of elderly patients with severe heart failure is poorer and the mortality is higher.Age,Diastolic blood pressure,blood creatinine,NT-proBNP and LVEF are the prognostic factors of all-cause death.
作者
张媛
刘佳梅
史琳影
陈牧雷
王欣
ZHANG Yuan;LIU Jia-mei;SHI Lin-ying;CHEN Mu-lei;WANG Xin(Heart Center and Beijing Key Laboratory of Hypertension Research,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中国心血管病研究》
CAS
2022年第7期620-625,共6页
Chinese Journal of Cardiovascular Research
基金
北京市医院管理中心临床技术创新项目(XMLX202135)。
关键词
老老年
心力衰竭
全因死亡
预测因素
Very elderly patients
Heart failure
All-cause mortality
Predictors
